Registered Nurse (RN) - Med Surg
North Mississippi Health Services
Tupelo, MS

**_Essential Functions_
Coordinates:**

* Consults with physician services
* Utilizes clinical diagnostics, physician documentation and non-physician clinical guidelines to facilitate status determination of inpatient, outpatient or outpatient observation.
* Coordinates final status with admitting and attending physicians
* Performs initial and concurrent clinical reviews as indicated by payer and patient clinical needs
* Inpatient and/or outpatient notification and precertification of services to payers
* Facilitates peer to peer, written reconsiderations or appeals throughout all denial cycle as appropriate
* Facilitates appropriate observation utilization
* Consults with patient financial services

**Educations:**

* Provides education and literature to physician services regarding IPPS and OPPS
* Educates physicians and other care team member on level of care criteria and other third party payer requirements

**Reporting/Recordkeeping:**

* Updates patient’s medical records as required
* Shares medical necessity documentation with payers to facilitate reimbursement

**Regulation**:

* Adheres to NMHS/NMMC Policies/Procedures/Guidelines
* Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues

**Requirements:**

* Associates Degree in Nursing, required; Bachelor’s Degree preferred
* Licensed as a Registered Nurse by the Mississippi Board of Nursing; required
* Minimum of 5 years clinical and/or healthcare experience; required
* Excellent organizational and communication (written and verbal) skills;  required
* Knowledge of various payer sources, federal/state laws/regulations, and cost containment; required
* Certified as an Accredited Case Manager (ACM); desirable
* Excellent interpersonal skills; required
* Demonstrates ability to care for a patient population from pediatric to geriatric; required